The general financial inspectorate carried out an audit mission with three health professions orders: doctors, pharmacists and dental surgeons. The report highlights dysfunctions, which concern regulatory and disciplinary missions but also governance and management. The mission recommends in the short term to fundamentally reform the three bodies, to make them institutions whose governance would be more open, with more supervised management and subject to administrative control.
The regulatory missions of the Orders are carried out in an unsatisfactory manner, notes the mission of the General Inspectorate of Finance in the first place.
• « The task of registering on the board is carried out correctly. However, registration procedures can be applied in a heterogeneous manner, within variable time frames and, in the case of the National Order of Dental Surgeons (ONCD), with incomplete verification of qualifications“. The mission also points out “ insufficient follow-up » from the table, “ registration not being followed by regular checks during the career of practitioners« .
• The Orders are also struggling “ to guarantee the independence of health professionals through the control of contracts which govern their professional activity“, according to her.
• Likewise, ” the control of links of interest with manufacturers under the anti-gift system is very insufficient« . « The National Order of Physicians (ONM) is unable to absorb the flow of declarations: 91,000 declarations have not been processed in 2024“, she notes by way of example.
• Finally, no Order correctly carries out its mission of monitoring compliance with Continuing Professional Development (CPD).
Disciplinary justice must also be overhauled to guarantee the protection of patients.
The mission is “ negligence in the processing of reports of particularly serious facts has been noted. In two of the three departmental councils of the Order of Physicians (CDOM) audited, reports of
situations that could be related to serious criminal offences, in particular sexual violence, were the subject of no follow-up or very insufficient follow-up such as simple reminders to the Order« .
• Furthermore, the report further emphasizes: “ disciplinary courts are faced with structural difficulties: difficulty in recruiting assessors from among the ordinal advisors, composition of the bodies not fully guaranteeing impartiality, lack of professionalization of procedures and adequate IT tools« .
Finally, the findings noted by the mission highlight the limits of the highly decentralized ordinal model.
• The organization of the Orders is based on territorialized structures, small in size, strongly attached to their autonomy. The number of elected officials is structurally high, disproportionate to the current tasks of the Orders, which are accomplished by salaried staff. The ratios observed are particularly high: up to 1 elected official for 44 practitioners at the ONCD.
• In the three Orders inspected, irregularities resulting from insufficient management control were identified.
The fragmentation of the organization and the autonomy of local levels lead to unjustified expenses with regard to the missions of the Orders, limits the professionalization of their management and accentuates dysfunctions.
• Poorly managed, the budgets of the Orders are characterized by an increase in the income from contributions and charges. With the exception of the National Order of Pharmacists (ONP), which has undertaken a strategy to reduce its reserves, the growth trajectory of contributions is continuous, even though their cash level remains high, notes the mission.
The findings drawn up by the mission call for at least a profound review of the organization and management of ordinal institutions.she emphasizes.
« These inadequacies reflect the intrinsic fragility of the ordinal model of regulation of health professions and lead to serious consequences in terms of patient protection.“, concludes the document. The mission recommends in the short term to fundamentally reform the Orders, to make them institutions whose governance would be more open, management more supervised and subject to administrative control. In addition to these necessary developments, two scenarios for profound transformation of the health professions regulation model could be studied:
- a scenario of abolition of the Orders of health professionals, whose missions would be
taken up by administrations and by common law administrative courts; - a scenario of merging all the health professions orders into a single entity,
supplemented by more robust supervision of its management rules and missions.
